Provider Demographics
NPI:1740551787
Name:COMMUNITY HEALTH CENTER OF LUBBOCK, INC.
Entity type:Organization
Organization Name:COMMUNITY HEALTH CENTER OF LUBBOCK, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-765-2611
Mailing Address - Street 1:1610 5TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79401-2622
Mailing Address - Country:US
Mailing Address - Phone:806-765-2611
Mailing Address - Fax:806-687-5826
Practice Address - Street 1:2401 FULTON AVE APT B
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79407-7727
Practice Address - Country:US
Practice Address - Phone:806-765-2600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY HEALTH CENTER OF LUBBOCK, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-01-23
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX295467901Medicaid